Title : Does Midazolam affect immediate cognitive function in elderly hepatocellular carcinoma patients undergoing radiofrequency ablation?
Background and Goal of study: Annually, Department of Anesthesiology serves 50,000 patients for both general and regional anesthesia. There were 127 and 120 geriatrics out of 288 and 366 patients undergoing total intravenous anesthesia (TIVA) for radiofrequency ablation (RFA) in 2015 and 2016 respectively. Normally, a radiologist uses thermal effect (90-100oC) to destroy hepatocellular carcinoma and its surrounding tissues at the distance of 2-5 centimeters. Currently, TIVA is the technique of choice using propofol, fentanyl and/or midazolam to provide a rapid, hypnosis, analgesia and control of amnesia during the procedure. However, the use of midazolam in elderly is not without adverse effects. It usually associates with an increased incidence of cognitive dysfunction. As a result, investigators would like to verify an early stage of cognitive decline by using the Montreal Cognitive Assessment (MoCA). This prospective study has been approved by Siriraj Institutional Review Board (COA: Si164/2018) and registered by Thai Clinical Trial Registry (TCTR20180913004) and written inform consent was obtained from all subject. There were 85 patients, both male and female, aged 65-80 years, ASA I-III, known case of hepatocellular carcinoma, receiving education more than grade 6, could communicate in listening, speaking, reading and writing. Owing to the administration of midazolam during the procedure was up to an anesthesiologist’s decision, patients were allocated into group A: 51 patients with midazolam, and group B: 34 patients without midazolam. Prior to the procedure, the scheduled patients treating with radiofrequency ablation (RFA), were invited to participate the study. Then the first Montreal Cognitive Assessment (MoCA) test was evaluated. During surgery, patient was monitored with oxygen saturation, pulse rate, and blood pressure, under the supervision of an anesthesiologist till the end of surgery. Then the patients were referred to the recovery room. The second MoCA test was performed when the patients gained conscious.
Take Away Notes: • In the near future, the world citizen becomes geriatric society which needs intensive care peri-operatively
• Montreal Cognitive Assessment (MoCA) test, a bedside assessment, is used to evaluate geriatric patient regarding cognitive function under midazolam administration